Q and A

Question

Why is my doctor only prescribing 2 ARVs?

Hi,

I was diagnosed a few weeks ago while being hospitalised with pneumonia, from which I have completely recovered meanwhile.

My CD4 count is 420, viral load 32.000. I should be starting with the treatment in just a few days. I have read pretty much everywhere that the treatment consists of 3 different medicines (in 3 pills or 1 or 2 “combo”pills.

According to my doctor, he wants to start with 2 medicines only – darunavir (Prezista) and etravirine (Intelence). When asked why not a third one, i was told it will be added later on.

Although i have a full trust in my doctor, i would still like to hear an alternative opinion on suggested treatment.

Thank you in advance for your answer, best regards…

Answer

Hello,

Thank-you for your email. I’m sorry to hear about your recent diagnosis, but I am glad to hear that you are taking control and learning about HIV treatment.

Unless you have a lot of drug resistance, meaning that you can not take certain ARVs, it is important that your combination is made up of 3 drugs. Occasionally darunavir and etravirine have been used alone as treatment for people with a lot of drug resistance. Because you have not been on treatment before, though, it is unlikely that you will have this extensive resistance.

It is important to start treatment with three ARVs at the same time. Starting with just two drugs means you would be more vulnerable to developing drug resistance as these may not be enough to surpress HIV replication.

It’s important to talk to your doctor about this again, and if neccessary seek a second opinion.
Etravirine is active in many people who developed resistance to either nevirapine or efavirenz. For this reason it is not generally used for first-line treatment in the UK. Etravirine interacts with many other HIV drugs. It can not be taken with other NNRTIs or with many protease inhibitors. It is most commonly used in combinations that include either two nucleosides and/or darunavir/ritonavir. I am not familiar with the guidelines for treatment in Slovakia but you could ask your doctor if this is the usual first treatment choice in your country, and if it is not why this is being recommended in your case.

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